Audio: “Hello. I’m Andrew Schorr for Banner MD Anderson Cancer Center. We’re talking about the signs and symptoms of skin cancer and also, the most serious and deadly form of skin cancer, melanoma. About two million American’s each year are diagnosed with skin cancer; about seventy-five thousand of them with melanoma. The name of the game is to recognize the signs and get treatment early. Unfortunately, about twelve thousand people a year die from skin cancer, about nine thousand of them from melanoma, so you can see how serious that is when it advances. To help us understand this is a surgical oncologist at Banner MD Anderson Cancer Center and that’s Dr. Mark Gimbel. Dr. Gimbel, thank you so much for being with us.”

Image: Mark Gimbel, M.D., on-camera

Audio: “Thank you, Andrew.”

Images: Dr. Gimbel and Andrew Schorr on-camera as each speak.

Andrew Schorr Audio: “Dr. Gimbel, let’s talk about what people should look for. What should they look for on their body? In Arizona, where there’s so much sunshine and that can be the villain here, what should they look for where they should go in and get checked?”

Dr. Gimbel Audio: “I think you hit the nail on the head. Early detection is key here. Being able to identify something on the skin that is new, that might be a cancer, is of utmost importance. So what somebody should look for is, although they have multiple moles or freckles on their skin normally, when they see something start to change or something that arises that wasn’t in a place before, that should put up their ears and say, ‘We’ve got a little bit of a concern. Let’s go ahead and get this checked out.’”

Andrew Schorr Audio: “So let’s say you had a mole or what you thought was an age spot on your skin but it started to bleed or ooze. I would think you go get that checked.”

Dr. Gimbel Audio: “Absolutely. And it doesn’t have to be just a mole. A lot of the skin cancers come up as not having any color. So there’s a pink, a pearly looking papule that’s on the skin, there are some other scaly lesions that are on the skin. Those are signs of a new skin lesion that’s arising and that would be something that you’d want to have looked at. And especially is it starts to bleed or ooze, that may be something more concerning.”

Andrew Schorr Audio: “Let’s talk about who’s at risk. I’ve often heard that people who have red hair, blonde hair, pale complexion, I mean we’re all at risk, but that they may be more at risk.”

Dr. Gimbel Audio: “You are correct. People who have fair skin and who are more likely to burn are at much higher risk of getting skin cancers. The skin makes its own protection using both carotene in the skin and then using something called melanocytes, or the melanin-producing cells in the skin. And those are what give you the tan that can protect your skin. However, when you start to burn and the melanocytes can’t react, then you put yourself at a much higher risk. And those patients who are fair or red hair do have a higher likelihood of burning and developing skin cancer.”

Andrew Schorr Audio: “The vast majority of people who develop skin cancer and, like I said, two-million American’s a year so it’s a lot of us, develop basal or squamous cell cancers. How do you treat those? Do you simply just cut them out and it’s not that big a deal? Or what is the treatment for those when those are observed?”

Dr. Gimbel Audio: “What you need to know about squamous cell and basal cell cancers is that they are pretty superficial cancers. They don’t penetrate too deeply into the skin. So the treatment for those, and especially if they’re caught early, is simple excision. You want to identify them. Typically, a dermatologist or your primary care physician can biopsy those and determine if this is a squamous cell. Sometimes there’s some characteristic appearance where these lesions can either be frozen, burned off or cut off. Those are all appropriate treatments and they need to be done narrowly because they don’t penetrate too deeply into the skin. The problem becomes when they aren’t recognized, they can grow bigger and, at late stage, albeit rare, they can spread.”

Andrew Schorr Audio: “Let’s talk about melanoma since it is the deadliest form of skin cancer. How is that different?”

Dr. Gimbel Audio: “Well, melanoma is going to be different from the basal call and the squamous cell. As I said, those first two are quite superficial in the skin. But melanoma has the propensity to grow deeper in the skin and the deeper it grows into the skin, the higher of a risk you have of it spreading. Once melanoma spreads, it can become a very deadly disease. But if you can catch it at the earlier stages, where it hasn’t made that deeper penetration or spread to the other areas, then you can really cure this disease.”

Andrew Schorr Audio: “So, early detection. People are, of course, familiar with Senator McCain, who’s had his journey with melanoma and we’re aware that he’s had some surgery. Tell us about the surgical procedures that you would do for melanoma.”

Dr. Gimbel Audio: “The surgical procedures for melanoma are actually going to be more extensive than they are for the squamous cell cancers and the basal cell cancers. With melanoma, not only does it grow deeper into the skin, but you can get little cells that spread itself around the actual lesion. So when you excise the melanoma, you want to make sure that you’re taking a margin of normal tissue. So while your melanoma may be, say, the size of the head of a pencil, you still need to take about a centimeter, or more depending on the depth of the actual melanoma, as a margin around the whole entire tumor. Eventually you’re looking upwards to at least something that’s the size of a silver dollar, or even greater, that needs to be excised.”

Andrew Schorr Audio: “Okay. And, of course, the concern is melanoma could spread to other parts of the body, right?”

Dr. Gimbel Audio: “When the melanoma grows deeper, there is that risk of having it spread to other areas. Typically, when melanoma spreads, it spreads through the skin, through lymphatics, to lymph nodes. The lymph nodes are in areas that are either in the arm pit or in the groin or the neck that start to grow and, if there’s melanoma in it, it can grow quite large and then it can spread from there. So with the deeper melanoma, many times what we do is excise not only the melanoma itself but then we check the lymph nodes as well to make sure that there hasn’t been any spread.”

Andrew Schorr Audio: “Okay. Of course, when melanoma has advanced, then that’s your teamwork with the medical oncologist to see, I imagine, if systemic therapy is needed.”

Dr. Gimbel Audio: “Yes. If we check the lymph node and there is melanoma within the lymph node, the standard treatment is then to take all of the lymph nodes out in that one area, which is a pretty big surgery, which show you how aggressive that this can be. And then, if it spreads beyond that, then we’re talking about working with a medical oncologist, possibly a radiation oncologist, to adequately treat the patient.”